The Effectiveness of Interventions Addressing the Social Determinants of Injuries: What do we think we know? What do we still need to find out? (Work in.

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Presentation on theme: "The Effectiveness of Interventions Addressing the Social Determinants of Injuries: What do we think we know? What do we still need to find out? (Work in."— Presentation transcript:

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The Effectiveness of Interventions Addressing the Social Determinants of Injuries: What do we think we know? What do we still need to find out? (Work in progress) Brian Hyndman, MHSc. Senior Planner Health Promotion, Chronic Disease and Injury Prevention Section, Public Health Ontario OIPRC Webinar January 25, 2012

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Health inequities Differences in population health status are primarily attributable to population-level disparities in the social determinants of health, including income, social status, education, and employment. The 2008 report by the Canadian Senate Subcommittee on Population Health¹ concluded that about 50% of health outcomes are attributable to social-economic factors ¹ Keon, W. J., and Pepin, L. (2009) A Healthy Productive Canada: A Determinant of Health Approach Ottawa: The Senate Subcommittee on Population Health

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Recent reports stress the need for a greater focus on the social determinants of health in order to reduce health inequities and improve population health outcomes

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SDOH and Preventable Injuries: Key Questions 1.What are the socio-economic determinants of health that are most likely to directly or indirectly affect injury/injury rates in Canada? 2.What is known about the mechanisms by which these determinants affect injury rates? 3.What is known about the effectiveness of interventions, including programs, policies and social marketing campaigns, aimed at preventing injury through addressing one or more of the underlying social determinants of health? 4.What are the key gaps in the literature linking injuries to the social determinants of health as well as the literature on the effectiveness of interventions aimed at preventing injury through addressing these determinants? * Builds on findings of 2006 SMARTRISK Environmental Scan commissioned by CIHI 5

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Inclusion/Exclusion Criteria for Journal Articles Published from 2000 – Focus on studies with Canadian content; studies with content from other countries included ONLY if part of a systematic review/meta- analysis OR focused on strategies applicable to Canadian context Did NOT include intentional injuries/suicides Used critical appraisal tool for public health research developed by Heller et al. (2008) to determine studies for inclusion 8

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Injuries and SES: what the literature tells us Generally, low SES groups have higher rates of injuries, which tend to be of greater severity and more often fatal Strength of inverse relationship between SES and injuries varies according to injury type and indicator of SES chosen Exceptions to Inverse Gradient B/W Injury and SES No clear relationship during adolescent years (a period of greater risk taking among young people across all socio-economic strata) Higher SES groups at greater risk of sports/recreational injuries 10

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Significance of relationship between Injury and SES “These differences in (injury hospitalization) rates imply that if every socio-economic group had experienced the same rate as the most affluent group, the national injury hospitalization rate could have been 8% lower. In other words, there would have been about 21,000 fewer injury hospitalizations in Canada.” Canadian Institute for Health Information (2010, p. 2) 14

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Injuries and SES: Implications for Interventions What the Literature tell us Lack of evidence on nature of the mechanisms underlying socio-economic differences in injury morbidity and mortality Vast majority of interventions focus on improving the knowledge and practices of “high risk” groups (presumably because broader determinants viewed as less amenable to change) Majority of interventions focus on childhood injuries (in the home or traffic environment) Limited evidence that interventions targeting more vulnerable populations are more effective at preventing injuries than population-level approaches; in fact, some studies show that disadvantaged groups receive a greater proportional benefit from population- level approaches (e.g., bicycle helmet legislation) 16

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Injuries and SES: Implications for Interventions What the Literature DOES NOT tell us At the population level, effective injury prevention programs are comprehensive and multi-faceted (i.e., the “three Es”: education, engineering and enforcement). Unclear to what extent these programs are reducing (or potentially exacerbating?) socio-economic inequities in injury outcomes In summary, existing studies provide a poor evidence base on how best to avoid – or narrow – socioeconomic differences in injury risk; it’s unclear what approaches to prevention work best where it’s needed most 18

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Conclusions More research on mechanisms by which SES may influence injury risk to guide development of effective programs and policies Need to determine impact of comprehensive, multi-component approaches to injury prevention, which have been shown to be effective at the population level, on disadvantaged groups – will help to determine optimal balance between targeted approaches, population-wide programs/policies and targeted universalism Advocate to reduce social inequalities contributing to injury inequalities 19